- Discussion:
    - scanning w/ gallium citrate Ga 67 has been suggested to be more accurate than technetium scanning in detecting bone and joint infections in children;
    - gallium works by localizing bacteria and inflammatory proteins in PMNs;
    - Borman et al in 1986 reported an accuracy rate of 91 % in 34 children, but cautioned that the radiation dose from gallium is higher than
           that from technetium or indium-111 and hence recommended its use only in difficult cases;
    - in typical study, Ga (67) is intravenously injected, and delayed images are aquired the next day;
    - earliey images are obtained, if urgent, but the target to background definition will be much better after 24 hrs;
    - osteomyelitis is suggested by focal uptake, however, any reactive bone process may also cause increased uptake;
    - in cases of frx, prosthesis, and preexisting complications, osteomyelitis cannot be confidently assessed with Ga;
    - since bone scan agents and Ga are usually both positive at fracture sites, they may have limited value, even in combination;
    - w/ no discernable uptake in reactive bone, In-WBC appears superior to Ga for evaluating fracture complications;
    - in chronic phases of repair, any degree of increased In-WBC uptake relative to adjacent bone appears to be abnormal